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Iatrogenic Ectasia after laser in situ

Iben Bach Damgaard, Mohamed Reffat, Jesper Hjortdal
Worldwide, femtosecond Laser Assisted In-situ Keratomileusis (LASIK) is a well known and commonly used refractive technique, although Small Incision Lenticule Extraction (SMILE) has become increasingly popular since it was introduced in 2011. In LASIK, a corneal flap is cut with a microkeratome or femtosecond laser, followed by thinning of the stromal bed with excimer laser ablation. In SMILE, a minor intrastromal lenticule is cut with a femtosecond laser and subsequently removed through a small incision, leaving the anterior and strongest part of the cornea almost intact...
2018: Open Ophthalmology Journal
David Tabibian, Cosimo Mazzotta, Farhad Hafezi
BACKGROUND: Corneal cross-linking (CXL) using ultraviolet light-A (UV-A) and riboflavin is a technique developed in the 1990's to treat corneal ectatic disorders such as keratoconus. It soon became the new gold standard in multiple countries around the world to halt the progression of this disorder, with good long-term outcomes in keratometry reading and visual acuity. The original Dresden treatment protocol was also later on used to stabilize iatrogenic corneal ectasia appearing after laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK)...
2016: Eye and Vision (London, England)
Theo G Seiler, Isaak Fischinger, Tobias Koller, Viktor Derhartunian, Theo Seiler
PURPOSE: To determine the safety of superficial corneal crosslinking after laser in situ keratomileusis (LASIK). SETTING: Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland. DESIGN: Prospective study. METHODS: Eyes with an ectasia risk score of 2 or higher were treated with standard LASIK (90 μm flap) for myopia correction, after which a rapid corneal crosslinking was performed in the interface (riboflavin 0...
October 2015: Journal of Cataract and Refractive Surgery
David Tabibian, Olivier Richoz, Farhad Hafezi
This article discusses corneal cross-linking (CXL) and how it transitioned from a modality for treating corneal ectatic disorders to an inventive means of treating infectious keratitis. Initially, CXL was successfully developed to halt the progression of ectatic diseases such as keratoconus, using the standard Dresden protocol. Later, indications were extended to treat iatrogenic ectasia developing after laser-assisted in situ keratomileusis (LASIK) and photo-refractive keratectomy (PRK). At the time, it had been postulated that the combination of ultraviolet light with riboflavin could not only biomechanically strengthen the cornea but also was capable of destroying living cells and organisms including keratocytes and pathogens...
January 2015: Journal of Ophthalmic & Vision Research
M Kohlhaas
Iatrogenic corneal ectasia is a rare complication but also one of the most feared situations that can occur after uneventful corneal laser surgery. Ectatic changes can occur as early as 1 week or can be delayed up to several years after LASIK. The actual incidence of ectasia is undetermined, an incidence rate of 0.04 to almost 2.8 % has been reported. Ectasia is most common following LASIK; however, cases have been reported following PRK and other corneal refractive procedures. Keratectasia shows progressive myopia, irregular astigmatism, ghosting, fluctuating vision and problems with scotopic vision...
June 2015: Klinische Monatsblätter Für Augenheilkunde
Majid Moshirfar, Jared G Smedley, Valliammai Muthappan, Allison Jarsted, Erik M Ostler
PURPOSE: To report the rate of postoperative ectasia after laser-assisted in situ keratomileusis (LASIK) with femtosecond laser-assisted flap creation, in a population of patients with no identified preoperative risk factors. METHODS: A retrospective case review of 1,992 eyes (1,364 patients) treated between March 2007 and January 2009 was conducted, with a follow up of over 4 years. After identifying cases of ectasia, all the patient charts were examined retrospectively for preoperative findings suggestive of forme fruste keratoconus (FFKC)...
2014: Clinical Ophthalmology
Muriel Poli, Pierre-Loic Cornut, Thomas Balmitgere, Florent Aptel, Hélène Janin, Carole Burillon
PURPOSE: To assess the efficacy and tolerance of corneal collagen cross-linking with corneal epithelium debridement in the stabilizing treatment of primary or secondary corneal ectasia. METHODS: Prospective, comparative, single-center study of patients presenting with progressive primary or secondary corneal ectasia. The control group, comprising the fellow eye of patients with bilateral involvement, was followed up for 6 months and then treated. The parameters examined were the biomicroscopic examination, visual acuity [best spectacle-corrected visual acuity (BSCVA) and uncorrected visual acuity (UCVA)], keratometry of the central 3 mm, intraocular pressure, central pachymetry, endothelial density, and macular profile...
May 2013: Cornea
G Pron, L Ieraci, K Kaulback
OBJECTIVE: The main objectives for this evidence-based analysis were to determine the safety and effectiveness of photochemical corneal collagen cross-linking with riboflavin (vitamin B(2)) and ultraviolet-A radiation, referred to as CXL, for the management of corneal thinning disease conditions. The comparative safety and effectiveness of corneal cross-linking with other minimally invasive treatments such as intrastromal corneal rings was also reviewed. The Medical Advisory Secretariat (MAS) evidence-based analysis was performed to support public financing decisions...
2011: Ontario Health Technology Assessment Series
Anastasios John Kanellopoulos, Perry S Binder
PURPOSE: To evaluate a series of patients with corneal ectasia after LASIK that underwent the Athens Protocol: combined topography-guided photorefractive keratectomy (PRK) to reduce or eliminate induced myopia and astigmatism followed by sequential, same-day ultraviolet A (UVA) corneal collagen cross-linking (CXL). METHODS: Thirty-two consecutive corneal ectasia cases underwent transepithelial PRK (WaveLight ALLEGRETTO) immediately followed by CXL (3 mW/cm(2)) for 30 minutes using 0...
May 2011: Journal of Refractive Surgery
Renato Ambrósio, Daniel G Dawson, Marcella Salomão, Frederico P Guerra, Ana Laura C Caiado, Michael W Belin
PURPOSE: To report a case of progressive corneal ectasia after LASIK with no detectable preoperative risk factors and to present three-dimensional corneal tomographic and biomechanical findings on the contralateral unoperated eye that would be considered low risk for ectasia and thereby a good LASIK candidate based on the Randleman Ectasia Risk Score System (ERSS). METHODS: A case report, literature review, and description of novel screening criteria based on Pentacam (Oculus Optikgeräte GmbH) corneal tomography are presented as well as Ocular Response Analyzer (ORA, Reichert Instruments) corneal biomechanical analysis...
November 2010: Journal of Refractive Surgery
Prema Padmanabhan, Aiswaryah Radhakrishnan, Radhika Natarajan
PURPOSE: To report a patient who developed bilateral corneal ectasia, during pregnancy, one and a half years after laser in situ keratomileusis for correction of myopia. METHOD: Case report with relevant literature review. RESULTS: A 20-year-old woman, with a stable myopic astigmatism underwent laser in situ keratomileusis for the correction of her refractive error. Preoperative clinical examination and topographic automated keratoconus screening did not suggest keratoconus in either eye...
May 2010: Cornea
César Villa-Collar, José Manuel González-Méijome, Ramón Gutiérrez-Ortega
PURPOSE: To report the clinical application of the measurement of luminous distortion under scotopic conditions and wavefront aberrations to objectively corroborate the optical and visual benefit of contact lens fitting to rehabilitate vision after complicated LASIK. METHODS: Seven eyes (four patients) that underwent LASIK for the correction of myopia with different postoperative visual complaints are reported in this observational case series. Luminous distortion index with the Starlights System v1...
July 2009: Journal of Refractive Surgery
George D Kymionis, Vasilios F Diakonis, Maria Kalyvianaki, Dimitra Portaliou, Charalampos Siganos, Vasilios P Kozobolis, Aristophanis I Pallikaris
PURPOSE: To investigate corneal tissue alterations after corneal collagen cross-linking in patients with post laser in situ keratosmileusis (LASIK) keratectasia and keratoconus. DESIGN: Prospective comparative case series. METHODS: Five patients (5 eyes) with iatrogenic keratectasia after LASIK and 5 patients (5 eyes) with progressive keratoconus were included. All eyes underwent corneal cross-linking and were assessed by corneal in vivo confocal microscopy...
May 2009: American Journal of Ophthalmology
R B Kucumen, N M Yenerel, E Gorgun, M Oncel
PURPOSE: To improve the visual acuity of patients with progressive keratectasia following laser in situ keratomileusis (LASIK). METHODS: Five eyes of four patients underwent penetrating keratoplasty for ectasia after LASIK: In one patient the second eye was operated on 10 months after the first keratoplasty. The pre- and postoperative refraction, best spectacle-corrected visual acuity, and topographic data were evaluated. RESULTS: The preoperative refraction was -20...
September 2008: European Journal of Ophthalmology
Dan Z Reinstein, Darren G Couch, Timothy Archer
We present a patient scheduled for LASIK enhancement based on conventional residual stromal thickness (RST) prediction methods in whom direct measurement of the RST changed the management due to an unexpectedly low RST. The preoperative refraction was -6.00 -0.50 x 115 in the right eye and -6.00 -0.50 x 20 in the left eye. At 9 months, the refractions had regressed to -0.50 -0.50 x 150 and -0.75 -0.25 x 145, respectively. Predicted RST based on preoperative parameters was 283 microm in the right eye and 281 microm in the left eye, sufficient for the planned enhancement...
November 2006: Journal of Cataract and Refractive Surgery
T Seiler
No abstract text is available yet for this article.
May 2005: Klinische Monatsblätter Für Augenheilkunde
Jim C Wang, Thierry J Hufnagel, Douglas F Buxton
We present a case of iatrogenic keratectasia in the left eye after laser in situ keratomileusis (LASIK) with 14 microm of stromal ablation. Preoperative evaluation did not show significant evidence of keratoconus or forme fruste keratoconus in either eye. Twenty months postoperatively, in addition to postoperative ectasia in the left eye, the right eye developed mild changes in manifest refraction and on corneal topography. A retrospective diagnosis of ectatic corneal disorder was made in a patient who had no obvious findings of corneal pathology prior to LASIK...
October 2003: Journal of Cataract and Refractive Surgery
Carlo F Lovisolo, Joseph F Fleming
PURPOSE: Intrastromal corneal ring segments (Intacs) were inserted in four eyes with iatrogenic keratectasia, 12 to 44 months after laser in situ keratomileusis (LASIK) in two patients and photorefractive keratectomy (PRK) in two patients, in order to avoid penetrating keratoplasty and to improve quality of vision. METHODS: A modified asymmetrical Intacs micro-thin prescription inserts implantation technique was used in three eyes where a 1.0-mm temporal incision and a superior-inferior dissection were performed...
September 2002: Journal of Refractive Surgery
Jorge Alió, Tamer Salem, Alberto Artola, Amr Osman
PURPOSE: To evaluate the potential of using intrastromal corneal ring technology (Intacs, KeraVision) to correct posterior ectasia after laser in situ keratomileusis (LASIK) for myopia. SETTING: Department of Cornea and Refractive Surgery, Instituto Oftalmológico de Alicante, and Miguel Hernández University School of Medicine, Alicante, Spain. METHODS: In this prospective noncomparative intervention case series, Intacs segments were implanted in 3 eyes that developed posterior ectasia after myopic LASIK with clear central corneas...
September 2002: Journal of Cataract and Refractive Surgery
Sanjay N Rao, Randy J Epstein
PURPOSE: Laser in situ keratomileusis (LASIK) has been associated with the development of postoperative corneal ectasia. We present a case of early onset ectasia after LASIK, review known risk factors in development, and discuss possible strategies for prevention. METHODS: A 39-year-old man underwent bilateral LASIK for moderate myopia. Preoperative cycloplegic refractions were -9.00 + 0.25 x 140 degrees OD and -7.75 sphere OS. Corneal topography demonstrated mild inferior steepening bilaterally although definite evidence of keratoconus by either the Klyce/Maeda and Smolek/Klyce keratoconus screening tests was not present...
March 2002: Journal of Refractive Surgery
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